Heart failure with normal ejection fraction; the V-HeFT study

In patients with clinical heart failure entered into the Veterans Administration Cooperative Study (V-HeFT) trial, 83 of 623 who had a baseline radionuclide measurement of left ventricular ejection fraction exhibited an ejection fraction of at least 0.45. When compared with the patients with an ejection fraction of less than 0.45, these subjects with apparent predominant diastolic dysfunction had a lower incidence of coronary artery disease (26.5% vs. 47.2%, p<0.001) and a higher incidence of preexisting hypertension (53.0% vs. 39.4%, p<0.02). In the normal ejection fraction group, systolic blood pressure was higher (129.7 vs. 117.7 mm Hg, p=0.0001), heart rate slower (75.0 vs. 83.2 beats/min, p=0.0001), cardiothoracic ratio smaller (0.512 vs. 0.536, p=0.002), echocardiographic left ventricular dimension smaller in diastole (61.7 vs. 69.2 mm, p=0.0001) and in systole (47.4 vs. 58.1 mm, p=0.0001), and posterior wall thickness greater (9.0 vs. 7.9 mm, p=0.004). Exercise tolerance was only slightly better in the normal ejection fraction group (peak oxygen consumption, 15.5 vs. 14.6 ml/kg/min, p=0.04). Prognosis in the normal ejection fraction patients (annual mortality rate, 8.0%) was significantly better than in the low ejection fraction group (annual mortality rate, 19.0%) (p=0.0001). Ventricular tachycardia on Holter monitor was a poor prognostic sign in these patients, and severe reduction in exercise tolerance also tended to predict poor outcome. Thus, heart failure with a normal ejection fraction has different demographics, different hemodynamics, and a different prognosis than heart failure with a low ejection fraction.